Quality
Is the care any good?
The US pays the most yet ranks last among peers on outcomes, penalizes roughly four in five hospitals for excess readmissions every year, still leaves six in ten hospitals short of a Leapfrog A grade even after a Spring 2026 jump, and wastes about a quarter of every health dollar on care that does not help.
Most spending, worst overall rank
Each dot is one country. Rank 1 is best. The US sits alone at the bottom right: highest spending, lowest overall rank.
Read it this way No peer country spends above 11.9 percent of GDP, yet the US spends 16.5 percent and still ranks 10th of 10. That combination licenses the conclusion that higher US spending is not converting into a better-performing system, though the chart alone cannot identify which specific spending choices are the problem.
⊞ data table⬇ CSV
| Country | Health spending (percent of GDP) | Overall rank |
|---|---|---|
| Australia | 9.8 | 1 |
| Netherlands | 10.1 | 2 |
| United Kingdom | 10.9 | 3 |
| New Zealand | 11.3 | 4 |
| France | 11.9 | 5 |
| Sweden | 10.9 | 6 |
| Canada | 11.2 | 7 |
| Switzerland | 11.7 | 8 |
| Germany | 11.8 | 9 |
| United States | 16.5 | 10 |
Commonwealth Fund, Mirror Mirror 2024 Exhibits · 2024 · source
Legislation in play that touches quality
- National Diabetes Project Act
- Access to Prescription Digital Therapeutics Act of 2025
- Women and Lung Cancer Research and Preventive Services Act of 2025
Counts from Congress.gov + state-legislation trackers, keyword-mapped to this Iron Triangle force. As of 2026-06-18. See the methodology note on the legislation dashboard.
Sources & methodology
- CMS Hospital-Acquired Condition Reduction Program, Provider Data Catalog
- CDC NHSN Annual SIR, Acute Care Hospitals
- Leapfrog Hospital Safety Grade, Spring 2024
- Leapfrog Hospital Safety Grade, state rankings
- Leapfrog and Johns Hopkins Armstrong Institute, Lives Lost Lives Saved
- CMS Hospital Readmissions Reduction Program Dataset
- KFF, 10 Years of Hospital Readmissions Penalties
- Commonwealth Fund, Mirror Mirror 2024
- Commonwealth Fund, Mirror Mirror 2024 Exhibits
- Commonwealth Fund, Mirror Mirror 2021 Exhibits
- CMS Office of the Actuary, National Health Expenditure Accounts
- OECD Health at a Glance 2023
- CDC/NCHS, Maternal Mortality Rates, 2024
- CMS Chronic Conditions Warehouse, Medicare beneficiary prevalence
- Goodman et al., Multimorbidity in Medicare, Annals of Internal Medicine
- ONC Data Brief, Interoperability among US Non-Federal Acute Care Hospitals
- ONC Information Blocking Claims Portal, Health IT Feedback
- ONC, Hospital Health Information Exchange and TEFCA Participation
- CMS QualityNet, HRRP Overview
- Shrank, Rogstad, and Parekh, Waste in the US Health Care System, JAMA
- Tan et al, Imaging for Older Patients with Acute Low Back Pain, JGIM
- Fleming-Dutra et al, Inappropriate Antibiotic Prescriptions, JAMA
- Chen et al, Preoperative Testing in Cataract Surgery, NEJM
- Kim et al, Low-Value PSA Testing, JAMA Network Open
- Institute of Medicine, Best Care at Lower Cost
- Berwick and Hackbarth, Eliminating Waste in US Health Care, JAMA
- Dartmouth Atlas of Health Care, Geographic Variation
- Fisher et al., Regional Variations in Medicare Spending, Annals of Internal Medicine
- CMS Provider Data Catalog · Hospital Care Compare
Per-chart citation straps carry the in-context detail; this is the full bibliography.